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Year 3 difficult topics > GI > Flashcards

GI Flashcards

1
Q

cirrhosis - end stage / late stage

compared to compensated cirrhosis

A

compensated - enough healthy cells

decompensated not longer enough healthy cells
hepatic encephalopathy ascites and esophageal / gastric variceal haemorrhage

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2
Q

compensated cirrhosis symptoms

A

loss of appetite
fatigues
muscle cramps
bruising and excessive bleeding as not enough clotting factors produced

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3
Q

why do caput medusae occur in cirrhosis?

A

cirrhosis > portal hypertension > engorged paraumbilical veins on abdomen wall

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4
Q

can gastroenteritis cause metabolic acidosis?

A

yes but ketones are not elevated

but alcholic ketoacidosis can also occur when glucose is not too low

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5
Q

why do alcoholics risk ketoacidosis?

treatment?

A

not reguarly eating / body breaks down body fat

also episodes of vomit
met acidosis > elevated anion gap> elevated serum ketones > normla or low glucose concentartion

infusion of saline and thiamine
avodi wernicke encephalopathy

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6
Q

IBD key differences

crohns has _____ _, _______,_______

A

crohns : skip lesions , granulomas, mucosa ro serosa all layers impacted, cobblestone appearance

UC: only upto sub mucosa is inflammed
crypt abscess
pseudopolyps

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7
Q

most common causative agent for peritonitis

what would be the neutrophil count on paracentesis ?

A

e.coli
>250 cells/uL
cefotaxime

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8
Q

Primary sclerosing cholangitis

hx
o/e
presents with what disease?
blood test results?

management

A

presents UC
pruritism - bilirubin

alt, ggt raised - biliary tree involvement

MRCP

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9
Q

PSC

Associations

Features
Investigation

A

UC
Crohns
HIV

jaundice, RUQ pain, bili raised and alp, fatigue

p-anca +
beaded appearance of biliary tree

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10
Q

where does mesenteric ischaemia present?

due to ?

pain?/ presentation

A

small bowel
embolic event
sudden onset, severe pain

urgent surgery
high mortality

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11
Q

ischaemic colitis

presents?

A

large bowel

thumbprinting

transient less severe symptoms / bloody diarrhoea

conservative management

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12
Q

bowel ischaemia risk factors

features

blood test finding

investigation?

A

atrial fibrillation
endocarditis
malignancy
smoking, htn, DM

cocaine

rectal bleed
diarrhoea
fever
elevated wcc and lactic acidosis

ct

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13
Q

why is thumbprinting seen in ischaemic colitis ?

A

abdominal xray sign due to mucosal oedema and haemorrhage

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14
Q

management of crohns- remission

A

azathioprine / mercaptopurine

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15
Q

first line treatment for UC

A

mesalazine

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16
Q

what is serious complication of mesalazine

how would this come up in an mcq

A

agranulocytosis

sore throat, fever w taking this drug for uc

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17
Q

A patient who is taking aminosalicylates and becomes unwell with a sore throat, fever, fatigue or bleeding gums needs an ?

A

urgent full blood count to rule out agranulocytosis.

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18
Q

Primary biliary cholangitis is associated with _____ ________ does / does not result in progressive obstructive jaundice.

A

such as Sjogren’s and does not result in progressive obstructive jaundice.

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19
Q

zollinger - ellison syndrome

A

excessive levels of gastrin
men type 1 syndrome

duodenal ulcers
diarrhoea
malabsorption

fasting gastrin levels
secretin stimulation test

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20
Q

budd chiari syndrome

A

hepatic vein thrombosis
haematological disease; polycythaemia vera / pregnancy, cop

TRIAD- sudden abdo pain, ascites, tender hepatomegaly

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21
Q

portal vein thrombosis

A

no hepatomegaly
thrombus before liver

affects vein supplying liver

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22
Q

pseudomembranous colitis which abx

A

ceftriaxone

co-amoxiclav
ciprofloxacin
clindamycin

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23
Q

crohns disease

  • perianal fistulae
  • investigation of choice
A

MRI pelvis

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24
Q

Treatment - Crohns
remission
ongoing

what needs to be assessed before giving dmards?

A

remission - prednisalone / dexamethasone
enteral feeding

2nd line :5-asa drugs / aminosalicylates : MESALAZINE

maintaining remission : azathiopurine

TPMT activity - thiopurine methytransferase activity

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25
Q

how if TPMT assessed

A

blood test

if your TPMT is low you should not receive aza

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26
Q

hepatitis screen results for someone that has immunity from a vaccine?
HBsAg
anti-HBc
anti-HBs

A

HBsAg-
anti hbc -
anti hbs +

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27
Q

HBsAg
anti-HBc
anti-HBs

what do these mean?

A

HBsAG - hepatitis b surface antigen- suggests current infection / infectious
can be either acute / chronic infection

Hepatitis core antibody : this would be present in an actual infection not vaccine

hepatitis surface antibody - vaccine / natural infection dependant on other results

28
Q

HBsAg
anti-HBc
anti-HBs

what do these mean?

A

HBsAG - hepatitis b surface antigen- suggests current infection / infectious
can be either acute / chronic infection

Hepatitis core antibody : this would be present in an actual infection not vaccine

hepatitis surface antibody - vaccine / natural infection dependant on other results

29
Q

acute / chronic infected w Hep B ?

A

HBsAG - positive

30
Q

hep b serology

A

HBsAg [acute disease1-6mo] - first marker > production of anti-hbs
anti-HBs always suggests immunity so if your hep is chronic / not resolving - CHRONIC disease

anti-HBc -caught the disease / core previous / current
IgM - current / 6mo
IgG- older

HbeAg- breakdown of core antigen so marker of infectivity

31
Q

coeliac disease

what condition is it associated with?
what condition can occur as a complication?

A

type 1 diabetes
autoimmune thyroid disease

dermatitis herpetiformis itchy blistering skin manifestation

32
Q

a rash that occurs on extensor surfaces like knees , elbows
the rash is itchy, vesicular

what is this rash diagnosis?
and what is the cause?

A

dermatitis herpetiformis

caused by coeliac disease

33
Q

what is the most common intra abdominal abscess

A

sub phrenic

34
Q

anti emetics

cyclizine

A

h1 receptor antagonist

35
Q

d2 receptor antagonist - anrti emetic

A

meoclopramide

36
Q

5ht3 receptor antagonist

A

ondansetron

37
Q

autoimmune hepatitis

A

ama and ana antibodies

38
Q

cholera management

A

fluid replacement

abx doxycycline

39
Q

anal fissure >6 weeks

A

chronic

40
Q

painful ictal bleeding?

A

anal fissure

41
Q

acute anal fissure mx?

A

soften stool
high fibre

high fluid intake

laxatives > lactulose

vaseline before defecating
topical anaesthetics
analgesia

42
Q

chronic anal fissure?

A

topical GTN

or surgery or botulinum toxin

43
Q

haemorrhoids

A

Location: 3, 7, 11 o’clock position
Internal or external
Treatment: Conservative, Rubber band ligation, Haemorrhoidectomy

44
Q

external haemorrhoids

A

prone to thrombosis

and painful

45
Q

internal haemorrhoids

A

painless

above dentate line

46
Q

examination reveals a purplish, oedematous, tender subcutaneous perianal mass

A

Acutely thrombosed external haemorrhoids

47
Q

outpatient treatment for haemorrhoids

A

rubber band ligation

injection sclerotherapy

48
Q

Patients may describe pain around the anus, which may be worse on sitting;
They may have also discovered some hardened tissue in the anal region;
There may be pus-like discharge from the anus;
If the abscess is longstanding, the patient may have features of systemic infection

what is it caused by commonly?

A

perianal abscess

e coli

49
Q

gold standard in imaging anorectal abscesses

A

MRI and transperineal ultrasound can be useful tools, with the former being the

50
Q

perianal abscess treatment

A

incision and drainage

51
Q

appendicitis scoring system?

A

alvarado

52
Q

haematemesis scoring system?

A

Blatchford - >6

Rockall

53
Q

coeliac disease - derm condition?

A

dermatitis herpetiformis

Mx: dapsone: abx

54
Q

definitive test for coeliac?

A

duodenal biopsy

55
Q

Diverticular complication?

A

localised perforation= abscess
faecal peritonitis
stricture
per rectum bleeding

56
Q

investigation for diverticular disease?

A

CT scan

57
Q

painless jaundice with a palpable mass in RUQ

what is investigation of choice

A

CT is the investigation of choice

58
Q

in a RUQ pain / jaundice what is imaging of choice?

A

USS
always
in MRCP

59
Q

how do you differentiate between large and small bowel obstruction?

A

in small bowel vomiting precedes abdominal distension

60
Q

UC risk factor for which cancer?

what if pt also has microcytic anaemia

A

right sided colon cancer

61
Q

gastrograffin

use?

A

diagnostic and therapeutic

opens up small bowel obstruction

62
Q

alarm bells for colonoscopy

A

per rectum - mixed with stool , tenesemus , urgency
weight loss
iron deficiency
recent change in bowel habits

63
Q

young pt
intermittent not progressive
both solids/ fluids

with a short hx?

A

achalasia

64
Q

fluid challenge

A

IV bolus 250-500mL / 30 mins

REASSESS

65
Q

maintenance fluids?

A

restore 2.5l fluid
100mM na+
70mM K+
Bag 1: 1 L of normal saline (=1 L of H O, 154 mM Na+, 154 mM Cl−) plus 20 mM K+, IV over 8 hours. 2
− Bag 2: 1 L of 5% dextrose (=1 L of H O, 50 g of dextrose), plus 20 mM K+, IV over 8 hours. 2
− Bag 3: 1 L of 5% dextrose (=1 L of H O, 50 g of dextrose), plus 20 mM K+, IV over 8 hours. 2
− Total: 3 L of H O, 154 mM Na+, 60 mM K+ over 24 hours.

66
Q

replacement fluids

A

Fever: febrile patients need an extra 500 mL of fluid for every 1oC above 37oC.
− Burns patients: patients with burns need extra fluids and this can be calculated using the Parkland
formula:
Fluids (mL) = 4 × weight (kg) × % surface area burnt

Year 3 difficult topics (22 decks)

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